Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.
Pathol Res Pract. 2019 Jun;215(6):152407. doi: 10.1016/j.prp.2019.03.035. Epub 2019 Apr 1.
Lung adenocarcinoma in young patients is a rare entity, and the targetable genomic alterations (GAs) are poorly studied. In other cancers, it has been demonstrated that young age defines unique disease biology. Here, the association of young age with GAs and prognosis is studied in a large cohort of Chinese patients.
We retrospectively screened 1000 consecutive patients, and identified 181 patients aged 40 years or younger. GAs were identified by next-generation sequencing (NGS) assay. The clinical and genetic characteristics were analyzed.
Among younger group, 167(92.3%) patients were diagnosed with advanced-stage adenocarcinoma, 98(54.1%) were female, 27(14.9%) were smokers, and the median age was 35 years. Targetable GAs which were significantly more common in the younger population (P < 0.001), were associated with young age (P < 0.05). The frequency of ALK translocations, EGFR and KRAS mutations was 37.6%, 34.3% and 6.1%, respectively. Younger patients had a higher prevalence of rare GAs including HER2, ROS1 and MET (P < 0.05). Prognosis for younger patients was similar (median OS of patients with GAs, 23.91 vs 23.67 months, P > 0.05) or better than that for older population (median OS of patients without GAs, 44.28 vs 41.88 months, P < 0.05) according to GAs. Therapy modality was an independent prognostic factor (P < 0.05), and 83% of death rate decreased if given preferred therapy.
Younger patients with lung adenocarcinoma had unique prevalence of targetable GAs. Comprehensive genotyping including NGS is recommended for personalized therapy and prognosis evaluation in this population.
年轻的肺腺癌患者较为少见，针对其可靶向的基因组改变（GA）的研究也较少。在其他癌症中，已经证明年轻的年龄定义了独特的疾病生物学特性。在此，我们通过对中国患者的大样本队列进行研究，探讨了年轻与 GA 和预后的关系。
我们回顾性筛选了 1000 例连续患者，发现 181 例患者年龄在 40 岁或以下。通过下一代测序（NGS）检测确定 GA。分析临床和遗传特征。
在年轻组中，167（92.3%）例患者被诊断为晚期腺癌，98（54.1%）例为女性，27（14.9%）例为吸烟者，中位年龄为 35 岁。在年轻人群中更常见的可靶向 GA（P<0.001）与年轻年龄（P<0.05）相关。ALK 易位、EGFR 和 KRAS 突变的发生率分别为 37.6%、34.3%和 6.1%。年轻患者罕见 GA 的发生率更高，包括 HER2、ROS1 和 MET（P<0.05）。有 GA 的年轻患者的预后与无 GA 的老年患者相似（GA 患者的中位 OS 为 23.91 个月 vs 23.67 个月，P>0.05）或更好（无 GA 患者的中位 OS 为 44.28 个月 vs 41.88 个月，P<0.05）。治疗方式是独立的预后因素（P<0.05），如果给予首选治疗，83%的死亡率降低。
肺腺癌年轻患者具有独特的可靶向 GA 发生率。建议对该人群进行包括 NGS 在内的综合基因分型，以进行个性化治疗和预后评估。
